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HomeMy WebLinkAboutSWG2021-00201 - SWG As-Built - 1/2/2026 f R Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWGZ0Z) — co 2 6 J Parcel# ( '9 o f' 7c'-- .69‘,/D Applicant Name val f/`io/s,_41 Subdivision (Name/Div/Block/Lot) Applicant Address Zh 2.9 4ie ¢ Ate, T-2 , oP jvg 4/w .. City, State, Zip ,,,, ` • _ s o Installer Name gel � /�t i•1a Site Address I� > �:�., . Designer Name e 4 ..i, "J`Ai 7 INSTALLATION CHECKLIST ull System Installation 0 Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other System Type SY , Pretreatment Type >5 ft.from foundation? - - 0 N/A el YES ❑ No >50 ft.from wells? - - ❑ 0 Y >50 ft.from surface water? - ❑ ❑ HCleanout between building and tank? - - 0 0 t? Tank baffles present? - - 0 0 a. 24'access risers over each compartment?- - 0 El LU Effluent filter installed?- •- 0 0 Septic tank capacity(working) LZCD L 90),_I .I Manufacturer A{,'� Y N 1U2,S QD-box water level and speed levelers used? - NIA 0 YES 0 NO QO Manifold/D-box accessible from surface?- ❑ al 0 mZ Check valves installed? - -- 0 Eli ❑Q ti al j 2 Transport Line Size 6 Schedule/Class CL 2t. O Bedrooms installed (check one) 0 2 3 ❑4 0 5 ❑6 0 Commercial/Other >10 ft.from foundation?- -- 0 N/A di YES 0 NO G >100 ft.from wells?- - 0 EV 0 iJ.l >100 ft.from surface water?- - El ❑ z >10 ft.from potable water lines?- - ElEl } >5 ft.from property lines and easements?- 0 0 d >30 ft. from downgradient curtain/foundation drains?- - ❑ ❑ D ainfield level and observation ports present - ❑ It Graveless chambers or El Clean gravel used? (check one) Proper - ❑ - ❑ Pro r cover installed over drainfield?- Pump tank setbacks consistent with septic tank?- C3 nun &It vFs 0 No Pump tank capacity(flood) 0--C(7 gal Manufacturer ;A0056 $Q ,t{ S 24"access riser(s)and accessible from surface? - ❑ alS ❑ a Alarm or Control Panel Insta -- • ❑ 0 Control Panel equipped wit Mar ETM/Counter- - ❑ Q a. Pump installed in 0 Bucket or i-On Block or ❑ Other a_ LL /Pump Make/Model ZO ER' N mi. - IN di Floatsor ❑ Transducer RTank draw down in/min Pumpcapacity P aci tY 75'r Qpm Squirt Height V ft • �e i Pump on time / d 016;e Pump off time dt.D iziy Daily flow set at 367, gpd Updated 621/2018 Mason County OSS installation Report pg. 2 Parcel# ‘'19 ' ' 7r-- /0 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES NO if yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? ----fN{-/&; 4] YES El NO , 1 i RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record f Drawings contain: Drainfield&manifold orientation&layout Septic/pump tank location,North arrow.reserve drainfield,ex,sting and proposed buildings,location of wells,waterlines, wells,observation ports deanouts.and other maintenance aaess points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. f l I 1 ���� �� I $ei i Record Drawing Attached CERTIFICATION OF INSTALLATION 1 1 INSTALLER DESIGNER!ENGINEER 1 certify that I installed the system in accordance with /certify that the system has been installed in accor- the septic design stamped'APPROVED"by Mason dance with the septic design stamped`APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all r and Mason County Codes. State and Mason County Codes I further certify that all Information contained on this i further certify that all information contained on this form and attac ed Record Drawl is accurate, form and attached Record Drawing is accurate. 9/-,l� s z Signature of taste er Date Eak '� VkL- S Klze.L.S� ~ c , ° 1 r A Printed Name of Signee 7 Or f •MASON COUNTY PUBLIC HEALTH 01$ r Y ' The undersigned approves this Installation Report andop w ky.. - Z8�BO Record Drawing on behalf of Mason County Public " c ' Heat • 'Z � I \1 1U. 9- , . Signature of Envimnm ntaslth 1 . 2 Specialist dabs (stamp, signature and date) 1 s THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE up�f121p8f8` i A —- — A _ V w % �n0 � IN Li Ck t�` °e b in • \. ....,. ..:-NA, 2, D s' 7s' `o to o ,• n C C C >' ti vl 10 11 w ;' s . f�i t rn 73 2 0 k ilUi Pi v z 0 ".0 \ k. 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